Rate Changes Hit Oklahoma's Drug Counselors

Oklahoma's certified alcohol and drug counselors are facing
reimbursement rate changes that industry leaders say are negatively
affecting a workforce that has decades of experience to offer.

The Oklahoma Health Care Authority, which administers the state's
Medicaid program, and the Oklahoma Department of Mental Health and
Substance Abuse Services are phasing in changes to the types of
services that certified alcohol and drug counselors (CADCs, a
bachelor's degree level position) can bill for, and the new rules
mean less money in their pockets. Instead, licensed alcohol and drug
counselors (LADCs) - a master's degree level certification - will be
the only ones who can bill for services like psychotherapy,
treatment plans and assessments, which provide a higher
reimbursement.

State leaders say they're making the changes to build a workforce
that is better equipped to deal with co-occurring disorders - both
mental health and substance abuse problems - and that many states
are headed in this direction. Directors of treatment centers and
advocates for the industry say they understand the move, but it's
forcing them to stop hiring CADCs and is cutting the salaries of
counselors who have decades of experience in the field.

"It's drastically changed the hiring practices in our field,"
said James Patterson, executive director of Specialized Outpatient
Services in Oklahoma City. "A lot of people have been let go, even
CADCs with long-term experience in addiction counseling. Some agency
directors have decided to only hire master's-level LADCs so they
have a better ability to provide the whole scope of services."

Patterson said that before the rule changes went into place, his
staff was made up of at least 50-percent CADCs. Now that position
makes up 20 percent of his personnel, he said. As CADCs have retired
or moved on, he hasn't filled their positions, he said, because he
can't afford to make up for the reimbursement they've lost. Other
treatment center directors have acted more quickly and have let
CADCs go, he said.

A CADC has been able to bill for codes that reimburse at a rate
of $8 every 15 minutes, Patterson said. When the reimbursement
changes are finished rolling out in 2013, that amount will have
dropped to $3.89 every 15 minutes, he said.

"Their functions are limited, and it gets harder and harder to
make the decision to keep that person," he said.

Oklahoma's law concerning the services that CADCs can provide
hasn't changed; they are still legally able to provide therapy and
do treatment plans, for example. But because the majority of
treatment facilities have contracts with OHCA and ODMHSAS, there are
few unaffected by the changes.

Ric Pierson, executive director of the Oklahoma State Board of
Licensed Alcohol and Drug Counselors, said some CADCs are going back
to school to earn master's degrees, but others who have five to 10
years left in their careers are opting not to spend the time and
money. A master's degree also doesn't mean a lot more money, Pierson
said. CADCs typically earn $28,000 to $32,000 a year, and LADCs make
$32,000 to $40,000, he said.

Statewide, the number of CADCs is dropping, Pierson said. Recent
numbers show there are 200 CADCs and 750 LADCs. Two years ago, those
numbers were 260 and 600, respectively.

Debbie Spaeth, director of behavioral health at the OHCA, said
the rule changes are an effort to treat the patient as a whole
individual, a move that's also occurring in the general medical
field. …

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